Odawara Sara, Shimbo Takuro, Yamauchi Toshimasa, Kobayashi Daiki
Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.
Department of Medicine, Ohta Nishinouchi Hospital, Fukushima 963-8558, Japan.
J Endocr Soc. 2023 Jul 20;7(8):bvad096. doi: 10.1210/jendso/bvad096. eCollection 2023 Jul 3.
Hyperthyroidism and overt and subclinical hypothyroidism are associated with major depression; however, the association of major depression across the spectrum of thyroid function within the normal range is unknown.
We investigated whether higher or lower levels of free thyroxine (T4) and thyrotropin (TSH) within the normal range are associated with major depression.
This was a retrospective cohort study of 66 960 participants with normal thyroid function who visited for health checkups (St. Luke's International Hospital, 2005-2018). The primary outcome was the development of major depression during the follow-up period. Participants were divided into 3 equal groups based on baseline free T4 or TSH values (low-, middle-, or high-normal), and the incidence of major depression was compared using the Cox proportional hazard model after adjusting for potential covariates.
During the median follow-up of 1883 days, 1363 (2.0%) patients developed major depression. The low-normal free T4 group had a significantly higher risk of major depression (adjusted HR 1.15; 95% CI, 1.01-1.31), but not the high-normal free T4 group or TSH groups. The association between low-normal free T4 and the development of major depression was maintained, rather more obvious, upon exclusion of participants whose thyroid hormone levels became abnormal during follow-up compared with data from all participants (adjusted HR 1.24; 95% CI, 1.07-1.43).
In this cohort, low-normal free T4 was associated with an increased risk of future major depression, even if subsequent hormone levels were maintained within the normal range. The magnitude of the impact of low-normal free T4 was relatively mild.
甲状腺功能亢进症、显性和亚临床甲状腺功能减退症与重度抑郁症有关；然而，正常范围内甲状腺功能全谱与重度抑郁症之间的关联尚不清楚。
我们研究了正常范围内游离甲状腺素（T4）和促甲状腺激素（TSH）水平的升高或降低是否与重度抑郁症有关。
这是一项对66960名甲状腺功能正常的参与者进行的回顾性队列研究，这些参与者前来进行健康检查（圣路加国际医院，2005 - 2018年）。主要结局是随访期间重度抑郁症的发生情况。根据基线游离T4或TSH值将参与者分为3个相等的组（低正常、中正常或高正常），并在调整潜在协变量后使用Cox比例风险模型比较重度抑郁症的发病率。
在1883天的中位随访期间，1363名（2.0%）患者发生了重度抑郁症。低正常游离T4组发生重度抑郁症的风险显著更高（调整后HR 1.15；95%CI，1.01 - 1.31），但高正常游离T4组或TSH组则不然。与所有参与者的数据相比，排除随访期间甲状腺激素水平变得异常的参与者后，低正常游离T4与重度抑郁症发生之间的关联得以维持，且更为明显（调整后HR 1.24；95%CI，1.07 - 1.43）。
在这个队列中，即使随后的激素水平维持在正常范围内，低正常游离T4也与未来发生重度抑郁症的风险增加有关。低正常游离T4的影响程度相对较轻。
